DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB 

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 

(See reverse for public burden disclosure.) 

1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: 

a. contract a. bid/offer/application a. initial filing 

b. grant b. initial award b. material change 

c. cooperative agreement c. post-award For Material Change Only: 

d. loan year _________ quarter _________ 

e. loan guarantee date of last report ______________ 

f. loan insurance 

4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name 

and Address of Prime: 

Tier ______, if known : 

Congressional District, if known : Congressional District, if known : 

6. Federal Department/Agency: 7. Federal Program Name/Description: 

CFDA Number, if applicable: _____________ 

8. Federal Action Number, if known : 9. Award Amount, if known : 

$ 

10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if 

(if individual, last name, first name, MI): different from No. 10a) 

(last name, first name, MI): 

11. Signature: 

Print Name: 

Title: 

Telephone No.: _______________________ 

Authorized for Local Reproduction 

Standard Form LLL (Rev. 7-97) 

Information requested through this form is authorized by title 31 U.S.C. section 

1352. This disclosure of lobbying activities is a material representation of fact 

upon which reliance was placed by the tier above when this transaction was made 

or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This 

information will be available for public inspection. 

required disclosure shall be subject to a 

not more than $100,000 for each such failure. 

Prime Subawardee 

Federal Use Only: 

Date: 

Any person who fails to file the 

civil penalty of not less than $10,000 and 
INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES


This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal 

action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreementto make 

payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof 

Congress, or an employeeof a Member of Congress in connectionwith a coveredFederalaction. Completeall items that apply for both the initial filing and material 

change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. 

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 

2. Identify the status of the covered Federal action. 

3. Identify the appropriateclassification of this report. If this is a followup report caused by a material change to the information previously reported, enter 

the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal 

action. 

4. Enter the full name, address, city, State and zip code of the reporting entity. Include CongressionalDistrict, if known. Check the appropriateclassification 

of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee 

of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 

5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal 

recipient. Include Congressional District, if known. 

6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For 

example, Department of Transportation, United States Coast Guard. 

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance 

(CFDA) number for grants, cooperative agreements, loans, and loan commitments. 

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; 

Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number 

assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001." 

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan 

commitment for the prime entity identified in item 4 or 5. 

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting 

entity identified in item 4 to influence the covered Federal action. 

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and 

Middle Initial (MI). 

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. 

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control 

Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is 

estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data 

needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of 

information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, 

DC 20503. 
OMB Number: 4040-0004

Expiration Date: 8/31/2016

Application for Federal Assistance SF-424

* 1. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letter(s):

Preapplication 

Application

New 

Continuation * Other (Specify):

Changed/Corrected Application Revision

* 3. Date Received: 4. Applicant Identifier:

5a. Federal Entity Identifier: 5b. Federal Award Identifier:

State Use Only:

6. Date Received by State: 7. State Application Identifier:

8. APPLICANT INFORMATION:

* a. Legal Name:

* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:

d. Address:

* Street1:

Street2:

* City: 

County/Parish:

* State:

Province:

* Country:

* Zip / Postal Code:

e. Organizational Unit:

DepartmentName: DivisionName:

f. Name and contact information of person to be contacted on matters involving this application:

Prefix: * First Name:

Middle Name:

* Last Name: 

Suffix:

Title:

Organizational Affiliation:

* Telephone Number: Fax Number:

* Email:

View Burden Statement

USA: UNITED STATES
Application for Federal Assistance SF-424

* 9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:

* Other (specify):

* 10. Name of Federal Agency:

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:

* 12. Funding Opportunity Number:

* Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

* 15. Descriptive Title of Applicant's Project:

Attach supporting documents as specified in agency instructions.

Add Attachments Delete Attachments View Attachments

Add Attachment Delete Attachment View Attachment
Application for Federal Assistance SF-424

16. Congressional Districts Of:

* a. Applicant

Attach an additional list of Program/Project Congressional Districts if needed.

* b.Program/Project

17. Proposed Project:

* a. Start Date: * b. End Date:

18. Estimated Funding ($):

* a. Federal

* b. Applicant

* c. State

* d. Local

* e. Other

* f. Program Income

* g. TOTAL

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

a. This application was made available to the State under the Executive Order 12372 Process for review on .

b. Program is subject to E.O. 12372 but has not been selected by the State for review.

c. Program is not covered by E.O. 12372.

* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.)

Yes No

If "Yes", provide explanation and attach

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements

herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to

comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may

subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

** I AGREE

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency 

specificinstructions.

Authorized Representative:

Prefix: * First Name:

Middle Name:

* Last Name:

Suffix:

* Title:

* TelephoneNumber:

* Email:

Fax Number:

* Signature ofAuthorized Representative: * Date Signed:

Add Attachment Delete Attachment View Attachment

Add Attachment Delete Attachment View Attachment
INSTRUCTIONS FOR THE SF-424

This is a standard form required for use as a cover sheet for submission of pre-applications and applications and related information under 

discretionary programs. Some of the items are required and some are optional at the discretion of the applicant or the federal agency (agency). 

Required fields on the form are identified with an asterisk (*) and are also specified as “Required” in the instructions below. In addition to these 

instructions, applicants must consult agency instructions to determine other specific requirements.

Item Entry: Item: Entry:

1. Type of Submission: (Required) Select one type of 

submission in accordance with agency instructions.

• Pre-application

• Application

• Changed/Corrected Application – Check if this submission 

is to change or correct a previously submitted application. 

Unless requested by the agency, applicants may not use this 

form to submit changes after the closing date.

10. Name Of Federal Agency: (Required) Enter the name of the 

federal agency from which assistance is being requested with 

this application.

11. Catalog Of Federal Domestic Assistance Number/Title:

Enter the Catalog of Federal Domestic Assistance number and 

title of the program under which assistance is requested, as 

found in the program announcement, if applicable.

2. Type of Application: (Required) Select one type of application 

in accordance with agency instructions.

• New – An application that is being submitted to an agency 

for the first time.

• Continuation - An extension for an additional funding/budget 

period for a project with a projected completion date. This 

can include renewals.

• Revision - Any change in the federal government’s financial 

obligation or contingent liability from an existing obligation. If 

a revision, enter the appropriate letter(s). More than one may 

be selected. If "Other" is selected, please specify in text box 

provided.

A. Increase Award D. Decrease Duration

B. Decrease Award E. Other (specify)

C. Increase Duration

12. Funding Opportunity Number/Title: (Required) Enter the 

Funding Opportunity Number (FON) and title of the opportunity 

under which assistance is requested, as found in the program 

announcement. 

13. Competition Identification Number/Title: Enter the competition 

identification number and title of the competition under which 

assistance is requested, if applicable.

14. Areas Affected By Project: This data element is intended for 

use only by programs for which the area(s) affected are likely 

to be different than the place(s) of performance reported on the 

SF-424 Project/Performance Site Location(s) Form. Add 

attachment to enter additional areas, if needed.

3. Date Received: Leave this field blank. This date will be 

assigned by the Federal agency.

15. Descriptive Title of Applicant’s Project: (Required) Enter a brief 

descriptive title of the project. If appropriate, attach a map 

showing project location (e.g., construction or real property 

projects). For pre-applications, attach a summary description 

of the project. 

4. Applicant Identifier: Enter the entity identifier assigned buy 

the Federal agency, if any, or the applicant’s control number 

if applicable.

5a. Federal Entity Identifier: Enter the number assigned to your 

organization by the federal agency, if any.

16. Congressional Districts Of: 16a. (Required) Enter the 

applicant’s congressional district. 16b. Enter all district(s) 

affected by the program or project. Enter in the format: 2 

characters state abbreviation – 3 characters district number, 

e.g., CA-005 for California 5th district, CA-012 for California 12 

district, NC-103 for North Carolina’s 103 district. If all 

congressional districts in a state are affected, enter “all” for the 

district number, e.g., MD-all for all congressional districts in 

Maryland. If nationwide, i.e. all districts within all states are 

affected, enter US-all. If the program/project is outside the US, 

enter 00-000. This optional data element is intended for use 

only by programs for which the area(s) affected are likely to be 

different than place(s) of performance reported on the SF-424 

Project/Performance Site Location(s) Form. Attach an 

additional list of program/project congressional districts, if 

needed.

5b. Federal Award Identifier: For new applications, enter NA. 

For a continuation or revision to an existing award, enter the 

previously assigned federal award identifier number. If a 

changed/corrected application, enter the federal identifier in 

accordance with agency instructions.

6. Date Received by State: Leave this field blank. This date will 

be assigned by the state, if applicable. 

7. State Application Identifier: Leave this field blank. This 

identifier will be assigned by the state, if applicable.

8. Applicant Information: Enter the following in accordance with 

agency instructions: 

a. Legal Name: (Required) Enter the legal name of applicant 

that will undertake the assistance activity. This is the 

organization that has registered with the Central Contractor 

Registry (CCR). Information on registering with CCR may be 

obtained by visiting www.Grants.gov. 

17. Proposed Project Start and End Dates: (Required) Enter the 

proposed start date and end date of the project.

b. Employer/Taxpayer Number (EIN/TIN): (Required) Enter 

the employer or taxpayer identification number (EIN or TIN) 

as assigned by the Internal Revenue Service. If your 

organization is not in the US, enter 44-4444444.

18. Estimated Funding: (Required) Enter the amount requested, or 

to be contributed during the first funding/budget period by each 

contributor. Value of in-kind contributions should be included 

on appropriate lines, as applicable. If the action will result in a 

dollar change to an existing award, indicate only the amount of 

the change. For decreases, enclose the amounts in 

parentheses.
c. Organizational DUNS: (Required) Enter the organization’s 

DUNS or DUNS+4 number received from Dun and 

Bradstreet. Information on obtaining a DUNS number may be 

obtained by visiting www.Grants.gov. 

19. Is Application Subject to Review by State Under Executive 

Order 12372 Process? (Required) Applicants should contact the 

State Single Point of Contact (SPOC) for Federal Executive 

Order 12372 to determine whether the application is subject to 

the State intergovernmental review process. Select the 

appropriate box. If “a.” is selected, enter the date the 

application was submitted to the State. 

d. Address: Enter address: Street 1 (Required); city 

(Required); County/Parish, State (Required if country is US), 

Province, Country (Required), 9-digit zip/postal code 

(Required if country US). 

20. Is the Applicant Delinquent on any Federal Debt?

(Required) Select the appropriate box. This question applies to 

the applicant organization, not the person who signs as the 

authorized representative. Categories of federal debt include; 

but, may not be limited to: delinquent audit disallowances, 

loans and taxes. If yes, include an explanation in an 

attachment. 

e. Organizational Unit: Enter the name of the primary 

organizational unit, department or division that will undertake 

the assistance activity. 

21. Authorized Representative: To be signed and dated by the 

authorized representative of the applicant organization. Enter 

the first and last name (Required); prefix, middle name, suffix. 

Enter title, telephone number, email (Required); and fax 

number. A copy of the governing body’s authorization for you 

to sign this application as the official representative must be on 

file in the applicant’s office. (Certain federal agencies may 

require that this authorization be submitted as part of the 

application.)

f. Name and contact information of person to be contacted on 

matters involving this application: Enter the first and last name 

(Required); prefix, middle name, suffix, title. Enter 

organizational affiliation if affiliated with an organization other 

than that in 7.a. Telephone number and email (Required); 

fax number. 

9. Type of Applicant: (Required) Select up to three applicant 

type(s) in accordance with agency instructions. 

A. State Government

B. County Government

C. City or Township 

Government

D. Special District 

Government

E. Regional Organization

F. U.S. Territory or 

Possession

G. Independent School 

District

H. Public/State 

Controlled Institution of 

Higher Education

I. Indian/Native 

American Tribal 

Government (Federally 

Recognized)

J. Indian/Native 

American Tribal 

Government (Other 

than Federally 

Recognized)

K. Indian/Native 

American Tribally 

Designated 

Organization

L. Public/Indian Housing 

Authority

M. Nonprofit

N. Private Institution of 

Higher Education

O. Individual

P. For-Profit 

Organization (Other 

than Small Business)

Q. Small Business

R. Hispanic-serving 

Institution

S. Historically Black 

Colleges and 

Universities (HBCUs)

T. Tribally Controlled 

Colleges and 

Universities (TCCUs)

U. Alaska Native and 

Native Hawaiian 

Serving Institutions

V. Non-US Entity

W. Other (specify)

[U.S Department of Education note: As of spring, 2010, the FON discussed in Block 12 of the instructions can be found via the 

following URL: http://www.grants.gov/applicants/find_grant_opportunities.jsp.]
U.S. Department of Education

Supplemental Information for the SF-424

1. Project Director:

Prefix: * First Name: Middle Name: * Last Name: Suffix:

 

 Address:

 * Street1:

 Street2:

 * City:

 County:

 * State: * Zip Code: Country:

 * Phone Number (give area code): Fax Number (give area code):

 * Email Address:

2. Novice Applicant:

 Are you are a novice applicant as defined in the regulations in 34 CFR 75.225 (and included in the 

 definitions page in the attached instructions)? 

 Yes No

3. Human Subjects Research:

 a. Are any research activities involving human subjects planned at any time during the

 proposed Project Period?

Yes No

 b. Are ALL the research activities proposed designated to be exempt from the regulations?

Yes Provide Exemption(s) # (s): ⁪ 1 ⁪ 2 ⁪ 3 ⁪ 4 ⁪ 5 ⁪ 6 

No Provide Assurance #(s), if available:

c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to this form 

as indicated in the definitions page in the attached instructions. 

OMB Number: 1894-0007 

Expiration Date: 8/31/2017

 
Instructions for U.S. Department of Education 

Supplemental Information for the SF-424

1. Project Director. Name, address, telephone and fax numbers, and e-mail address of the person to be contacted on matters involving this 

application. Items marked with an asterisk (*) are mandatory.

2. Novice Applicant. Check “Yes” if you meet the definition for novice applicants specified in the regulations in 34 CFR 75.225 and included 

on the attached page entitled “Definitions for U.S. Department of Education Supplemental Information for the SF-424”). By checking “Yes” 

the applicant certifies that it meets these novice applicant requirements. Check “No” if you do not meet the definition for novice applicants.

This novice applicant information will be used by ED to: 1) determine the amount and type of technical assistance that a novice might need, if 

funded, and 2) determine novice applicant eligibility in discretionary grant competitions that give special consideration to novice applications. 

Certain ED discretionary grant programs give special consideration to novice applications, either by establishing a special competition for 

novice applicants or by giving competitive preference to novice applicants under the procedures in 34 CFR 75.105(c)(2). If special 

consideration is being given to novice applications under a particular discretionary grant competition, the application notice for the competition 

published in the Federal Register will specify this information

3. Human Subjects Research. (See I. A. “Definitions” in attached page entitled “Definitions for U.S. Department of Education Supplemental 

Information for the SF-424.”)

3a. If Not Human Subjects Research. Check “No” if research activities involving human subjects are not planned at any time during the 

proposed project period. The remaining parts of Item 3 are then not applicable.

3a. If Human Subjects Research. Check “Yes” if research activities involving human subjects are planned at any time during the proposed 

project period, either at the applicant organization or at any other performance site or collaborating institution. Check “Yes” even if the 

research is exempt from the regulations for the protection of human subjects. (See I. B. “Exemptions” in attached page entitled “Definitions for 

U.S. Department of Education Supplemental Information for SF-424.”) 

3b. If Human Subjects Research is Exempt from the Human Subjects Regulations. Check “Yes” if all the research activities proposed are 

designated to be exempt from the regulations. Check the exemption number(s) corresponding to one or more of the six exemption categories 

listed in I. B. “Exemptions.” In addition, follow the instructions in II. A. “Exempt Research Narrative” in the attached page entitled 

“Definitions for U.S. Department of Education Supplemental Information for the SF-424.” 

3b. If Human Subjects Research is Not Exempt from Human Subjects Regulations. Check “No” if some or all of the planned research 

activities are covered (not exempt). In addition, follow the instructions in II. B. “Nonexempt Research Narrative” in the attached page entitled 

“Definitions for U.S. Department of Education Supplemental Information for the SF-424.”

3b. Human Subjects Assurance Number. If the applicant has an approved Federal Wide Assurance (FWA) on file with the Office for 

Human Research Protections (OHRP), U.S. Department of Health and Human Services, that covers the specific activity, insert the number in 

the space provided. (A list of current FWAs is available at: http://ohrp.cit.nih.gov/search/search.aspx?styp=bsc) If the applicant does not 

have an approved assurance on file with OHRP, enter “None.” In this case, the applicant, by signature on the SF-424, is declaring that it will 

comply with 34 CFR 97 and proceed to obtain the human subjects assurance upon request by the designated ED official. If the application is 

recommended/selected for funding, the designated ED official will request that the applicant obtain the assurance within 30 days after the 

specific formal request.

3c. If applicable, please attach your “Exempt Research” or “Nonexempt Research” narrative to your submission of the U.S Department of 

Education Supplemental Information for the SF-424 form as instructed in item II, “Instructions for Exempt and Nonexempt Human Subjects 

Research Narratives” in the attached page entitled “Definitions for U.S. Department of Education Supplemental Information for the SF-424.” 

Note about Institutional Review Board Approval. ED does not require certification of Institutional Review Board approval with the 

application. However, if an application that involves non-exempt human subjects research is recommended/selected for funding, the designated 

ED official will request that the applicant obtain and send the certification to ED within 30 days after the formal request.

No covered human subjects research can be conducted until the study has ED clearance for protection of human 

subjects in research.

Public Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection 

displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 20 minutes per 

response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing 

and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (20 USC 3474 

General Education Provisions Act). Send comments regarding the burden estimate or any other aspect of this collection of information, 

including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or 

email ICDocketMgr@ed.gov and reference the OMB Control Number 1894-0007. Note: Please do not return the completed ED SF 424 

Supplemental Form to this address.
Definitions for U.S. Department of Education 

Supplemental Information for the SF-424

Definitions:

Novice Applicant (See 34 CFR 75.225)

For discretionary grant programs, novice applicant means any 

applicant for a grant from ED that—

• Has never received a grant or subgrant under the 

program from which it seeks funding;

• Has never been a member of a group application, 

submitted in accordance with 34 CFR 75.127-75.129, 

that received a grant under the program from which it 

seeks funding; and

• Has not had an active discretionary grant from the 

Federal government in the five years before the 

deadline date for applications under the program. For 

the purposes of this requirement, a grant is active until 

the end of the grant’s project or funding period, 

including any extensions of those periods that extend 

the grantee’s authority to obligate funds.

In the case of a group application submitted in accordance with 

34 CFR 75.127-75.129, a group includes only parties that meet 

the requirements listed above.

PROTECTION OF HUMAN SUBJECTS IN RESEARCH

I. Definitions and Exemptions

A. Definitions.

A research activity involves human subjects if the activity is 

research, as defined in the Department’s regulations, and the 

research activity will involve use of human subjects, as defined 

in the regulations.

—Research

The ED Regulations for the Protection of Human Subjects, Title 

34, Code of Federal Regulations, Part 97, define research as “a 

systematic investigation, including research development, 

testing and evaluation, designed to develop or contribute to 

generalizable knowledge. Activities which meet this definition 

constitute research whether or not they are conducted or 

supported under a program that is considered research for other 

purposes. For example, some demonstration and service 

programs may include research activities.

—Human Subject

The regulations define human subject as “a living individual 

about whom an investigator (whether professional or student) 

conducting research obtains (1) data through intervention or 

interaction with the individual, or (2) identifiable private 

information.” (1) If an activity involves obtaining information 

about a living person by manipulating that person or that 

person’s environment, as might occur when a new instructional 

technique is tested, or by communicating or interacting with the 

individual, as occurs with surveys and interviews, the definition 

of human subject is met. (2) If an activity involves obtaining 

private information about a living person in such a way that the 

information can be directly or indirectly linked to that 

individual), the definition of human subject is met [Private 

information includes information about behavior that occurs in a 

context in which an individual can reasonably expect that no 

observation or recording is taking place, and information which 

has been provided for specific purposes by an individual and 

which the individual can reasonably expect will not be made 

public (for example, a school health record).]

B. Exemptions.

Research activities in which the only involvement of human 

subjects will be in one or more of the following six categories of 

exemptions are not covered by the regulations:

(1) Research conducted in established or commonly accepted 

educational settings, involving normal educational practices, 

such as (a) research on regular and special education 

instructional strategies, or (b) research on the effectiveness of or 

the comparison among instructional techniques, curricula, or 

classroom management methods. If an educational practice is 

being introduced to the site and is not widely used for similar 

populations, it is not covered by this exemption.

(2) Research involving the use of educational tests (cognitive, 

diagnostic, aptitude, achievement), survey procedures, interview 

procedures or observation of public behavior, unless: (a) 

information obtained is recorded in such a manner that human 

subjects can be identified, directly or through identifiers linked 

to the subjects; and (b) any disclosure of the human subjects’ 

responses outside the research could reasonably place the 

subjects at risk of criminal or civil liability or be damaging to 

the subjects’ financial standing, employability, or reputation. If 

the subjects are children, exemption 2 applies only to research 

involving educational tests and observations of public behavior 

when the investigator(s) do not participate in the activities 

being observed. 

Exemption 2 does not apply if children are surveyed or 

interviewed or if the research involves observation of public 

behavior and the investigator(s) participate in the activities 

being observed. [Children are defined as persons who have not 

attained the legal age for consent to treatments or procedures 
involved in the research, under the applicable law or jurisdiction 

in which the research will be conducted.]

(3) Research involving the use of educational tests (cognitive, 

diagnostic, aptitude, achievement), survey procedures, interview 

procedures or observation of public behavior that is not exempt 

under section (2) above, if the human subjects are elected or 

appointed public officials or candidates for public office; or 

federal statute(s) require(s) without exception that the 

confidentiality of the personally identifiable information will be 

maintained throughout the research and thereafter.

(4) Research involving the collection or study of existing data, 

documents, records, pathological specimens, or diagnostic 

specimens, if these sources are publicly available or if the 

information is recorded by the investigator in a manner that 

subjects cannot be identified, directly or through identifiers 

linked to the subjects. [This exemption applies only to 

retrospective studies using data collected before the initiation 

of the research.]

(5) Research and demonstration projects which are conducted 

by or subject to the approval of department or agency heads, and 

which are designed to study, evaluate, or otherwise examine: 

(a) public benefit or service programs; (b) procedures for 

obtaining benefits or services under those programs; (c) possible 

changes in or alternatives to those programs or procedures; or 

(d) possible changes in methods or levels of payment for 

benefits or services under those programs. [The standards of 

this exemption are rarely met because it was designed to apply 

only to specific research conducted by the Social Security 

Administration and some Federal welfare benefits programs.]

(6) Taste and food quality evaluation and consumer acceptance 

studies, (a) if wholesome foods without additives are consumed 

or (b) if a food is consumed that contains a food ingredient at or 

below the level and for a use found to be safe, or agricultural 

chemical or environmental contaminant at or below the level 

found to be safe, by the Food and Drug Administration or 

approved by the Environmental Protection Agency or the Food 

Safety and Inspection Service of the U.S. Department of 

Agriculture.

II. Instructions for Exempt and Nonexempt Human 

Subjects Research Narratives

If the applicant marked “Yes” for Item 3.b. of the U.S. 

Department of Education Supplemental Information for the SF 

424, the applicant must attach a human subjects “exempt 

research” or “nonexempt research” narrative to the U.S. 

Department of Education Supplemental Information for the SF424 form. If you have multiple projects and need to provide 

more than one narrative, be sure to label each set of responses as 

to the project they address.

A. Exempt Research Narrative.

If you marked “Yes” for item 3.b. and designated exemption 

numbers(s), attach the “exempt research” narrative to the U.S.

Department of Education Supplemental Information for the SF424. The narrative must contain sufficient information about the 

involvement of human subjects in the proposed research to 

allow a determination by ED that the designated exemption(s) 

are appropriate. The narrative must be succinct.

B. Nonexempt Research Narrative.

If you marked “No” for item 3.b. you must attach the 

“nonexempt research” narrative to the U.S. Department of 

Education Supplemental Information for the SF-424. The 

narrative must address the following seven points. Although no 

specific page limitation applies to this section of the application, 

be succinct.

(1) Human Subjects Involvement and Characteristics: 

Provide a detailed description of the proposed involvement of 

human subjects. Describe the characteristics of the subject 

population, including their anticipated number, age range, and 

health status. Identify the criteria for inclusion or exclusion of 

any subpopulation. Explain the rationale for the involvement of 

special classes of subjects, such as children, children with 

disabilities, adults with disabilities, persons with mental 

disabilities, pregnant women, prisoners, institutionalized 

individuals, or others who are likely to be vulnerable

(2) Sources of Materials: Identify the sources of research 

material obtained from individually identifiable living human 

subjects in the form of specimens, records, or data. Indicate 

whether the material or data will be obtained specifically for 

research purposes or whether use will be made of existing 

specimens, records, or data.

(3) Recruitment and Informed Consent: Describe plans for 

the recruitment of subjects and the consent procedures to be 

followed. Include the circumstances under which consent will 

be sought and obtained, who will seek it, the nature of the 

information to be provided to prospective subjects, and the 

method of documenting consent. State if the Institutional 

Review Board (IRB) has authorized a modification or waiver of 

the elements of consent or the requirement for documentation of 

consent.

(4) Potential Risks: Describe potential risks (physical, 

psychological, social, legal, or other) and assess their likelihood 

and seriousness. Where appropriate, describe alternative 

treatments and procedures that might be advantageous to the 

subjects.

(5) Protection Against Risk: Describe the procedures for 

protecting against or minimizing potential risks, including risks 

to confidentiality, and assess their likely effectiveness. Where 

appropriate, discuss provisions for ensuring necessary medical 

or professional intervention in the event of adverse effects to the 

subjects. Also, where appropriate, describe the provisions for 

monitoring the data collected to ensure the safety of the 

subjects.

(6) Importance of the Knowledge to be Gained: Discuss the 

importance of the knowledge gained or to be gained as a result 
of the proposed research. Discuss why the risks to subjects are 

reasonable in relation to the anticipated benefits to subjects and 

in relation to the importance of the knowledge that may 

reasonably be expected to result.

(7) Collaborating Site(s): If research involving human subjects 

will take place at collaborating site(s) or other performance 

site(s), name the sites and briefly describe their involvement or 

role in the research.

Copies of the Department of Education’s Regulations for the 

Protection of Human Subjects, 34 CFR Part 97 and other 

pertinent materials on the protection of human subjects in 

research are available from the Office of the Chief Financial 

Officer, U.S. Department of Education, Washington, D.C. 

20202-4331, telephone: (202) 245-8090, and on the U.S.

Department of Education’s Protection of Human Subjects in 

Research Web Site: 

http://www.ed.gov/about/offices/list/ocfo/humansub.html

NOTE: The State Applicant Identifier on the SF-424 is for 

State Use only. Please complete it on the SF-424 in the upper 

right corner of the form (if applicable).
OMB Control No. 1894-0005 (Exp. 03/31/2017)

NOTICE TO ALL APPLICANTS

The purpose of this enclosure is to inform you about 

a new provision in the Department of Education's 

General Education Provisions Act (GEPA) that 

applies to applicants for new grant awards under 

Department programs. This provision is Section 427 

of GEPA, enacted as part of the Improving America's 

Schools Act of 1994 (Public Law (P.L.) 103-382).

To Whom Does This Provision Apply?

Section 427 of GEPA affects applicants for new grant 

awards under this program. ALL APPLICANTS 

FOR NEW AWARDS MUST INCLUDE 

INFORMATION IN THEIR APPLICATIONS 

TO ADDRESS THIS NEW PROVISION IN 

ORDER TO RECEIVE FUNDING UNDER THIS 

PROGRAM.

(If this program is a State-formula grant program, a 

State needs to provide this description only for 

projects or activities that it carries out with funds 

reserved for State-level uses. In addition, local 

school districts or other eligible applicants that apply 

to the State for funding need to provide this 

description in their applications to the State for 

funding. The State would be responsible for ensuring 

that the school district or other local entity has 

submitted a sufficient section 427 statement as 

described below.)

What Does This Provision Require?

Section 427 requires each applicant for funds (other 

than an individual person) to include in its 

application a description of the steps the applicant 

proposes to take to ensure equitable access to, and 

participation in, its Federally-assisted program for 

students, teachers, and other program beneficiaries 

with special needs. This provision allows applicants 

discretion in developing the required description. 

The statute highlights six types of barriers that can 

impede equitable access or participation: gender, 

race, national origin, color, disability, or age. Based 

on local circumstances, you should determine 

whether these or other barriers may prevent your 

students, teachers, etc. from such access or 

participation in, the Federally-funded project or 

activity. The description in your application of steps 

to be taken to overcome these barriers need not be 

lengthy; you may provide a clear and succinct 

description of how you plan to address those barriers 

that are applicable to your circumstances. In 

addition, the information may be provided in a single 

narrative, or, if appropriate, may be discussed in 

connection with related topics in the application.

Section 427 is not intended to duplicate the 

requirements of civil rights statutes, but rather to 

ensure that, in designing their projects, applicants for 

Federal funds address equity concerns that may affect 

the ability of certain potential beneficiaries to fully 

participate in the project and to achieve to high 

standards. Consistent with program requirements and 

its approved application, an applicant may use the 

Federal funds awarded to it to eliminate barriers it 

identifies.

What are Examples of How an Applicant Might 

Satisfy the Requirement of This Provision?

The following examples may help illustrate how an 

applicant may comply with Section 427.

(1) An applicant that proposes to carry out an 

adult literacy project serving, among others, 

adults with limited English proficiency, might 

describe in its application how it intends to 

distribute a brochure about the proposed project 

to such potential participants in their native 

language.

(2) An applicant that proposes to develop 

instructional materials for classroom use might 

describe how it will make the materials available 

on audio tape or in braille for students who are 

blind.

(3) An applicant that proposes to carry out a 

model science program for secondary students 

and is concerned that girls may be less likely 

than boys to enroll in the course, might indicate 

how it intends to conduct "outreach" efforts to 

girls, to encourage their enrollment.

(4) An applicant that proposes a project to 

increase school safety might describe the special 

efforts it will take to address concern of lesbian, 

gay, bisexual, and transgender students, and 

efforts to reach out to and involve the families of 

LGBT students

We recognize that many applicants may already be 

implementing effective steps to ensure equity of 

access and participation in their grant programs, and 

we appreciate your cooperation in responding to the 

requirements of this provision.

 Estimated Burden Statement for GEPA Requirements

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of 

information unless such collection displays a valid OMB control number. Public reporting burden for this 

collection of information is estimated to average 1.5 hours per response, including time for reviewing 

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and 

reviewing the collection of information. The obligation to respond to this collection is required to obtain or 

retain benefit (Public Law 103-382. Send comments regarding the burden estimate or any other aspect of this 

collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 

400 Maryland Ave., SW, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 

1894-0005. 
Certification for Contracts, Grants, Loans, and Cooperative Agreements

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for 

influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an 

officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal 

contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard 

Form-LLL, ''Disclosure of Lobbying Activities,'' in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents 

for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and 

cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification 

is a material representation of fact upon which reliance was placed when this transaction was made or 

entered into. Submission of this certification is a prerequisite for making or entering into this transaction 

imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be

subject to a civil penalty of not less than $10,00 0 and not more than $100,000 for each such failure. 

If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer

or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of

a Member of Congress in connection with this commitment providing for the United States to insure or 

guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying 

Activities,'' in accordance with its instructions. Submission of this statement is a prerequisite for making or 

entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the

required statement shall be subjec t to a civil penalty of not less than $10,000 and not more than $100,000

for each such failure.

* APPLICANT'S ORGANIZATION

* SIGNATURE: * DATE:

* PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

Suffix:

Middle Name:

* Title:

* First Name:

* Last Name:

Prefix:

CERTIFICATION REGARDING LOBBYING

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any

person for influencing or attempting to influence an officer or employee of an agency, a Member of 

Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with 

the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the

entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or 

modification of any Federal contract, grant, loan, or cooperative agreement.

The undersigned certifies, to the best of his or her knowledge and belief, that:

Statement for Loan Guarantees and Loan Insurance 

The undersigned states, to the best of his or her knowledge and belief, that:
OMB Approval No. 0348-0040

ASSURANCES - NON-CONSTRUCTION PROGRAMS

NOTE:

As the duly authorized representative of the applicant, I certify that the applicant:

Previous Edition Usable Standard Form 424B (Rev. 7-97)

Authorized for Local Reproduction Prescribed by OMB Circular A-102

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of

information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for

reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.

SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the

awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such

is the case, you will be notified.

Has the legal authority to apply for Federal assistance

and the institutional, managerial and financial capability

(including funds sufficient to pay the non-Federal share

of project cost) to ensure proper planning, management

and completion of the project described in this

application.

Will give the awarding agency, the Comptroller General

of the United States and, if appropriate, the State,

through any authorized representative, access to and

the right to examine all records, books, papers, or

documents related to the award; and will establish a

proper accounting system in accordance with generally

accepted accounting standards or agency directives.

Will establish safeguards to prohibit employees from

using their positions for a purpose that constitutes or

presents the appearance of personal or organizational

conflict of interest, or personal gain.

Will initiate and complete the work within the applicable

time frame after receipt of approval of the awarding

agency.

Will comply with the Intergovernmental Personnel Act of

1970 (42 U.S.C. §§4728-4763) relating to prescribed

standards for merit systems for programs funded under

one of the 19 statutes or regulations specified in

Appendix A of OPM's Standards for a Merit System of

Personnel Administration (5 C.F.R. 900, Subpart F).

Will comply with all Federal statutes relating to

nondiscrimination. These include but are not limited to:

(a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)

which prohibits discrimination on the basis of race, color

or national origin; (b) Title IX of the Education

Amendments of 1972, as amended (20 U.S.C. §§1681-

1683, and 1685-1686), which prohibits discrimination on 

the basis of sex; (c) Section 504 of the Rehabilitation

Act of 1973, as amended (29 U.S.C. §794), which

prohibits discrimination on the basis of handicaps; (d)

the Age Discrimination Act of 1975, as amended (42

U.S.C. §§6101-6107), which prohibits discrimination

on the basis of age; (e) the Drug Abuse Office and

Treatment Act of 1972 (P.L. 92-255), as amended,

relating to nondiscrimination on the basis of drug

abuse; (f) the Comprehensive Alcohol Abuse and

Alcoholism Prevention, Treatment and Rehabilitation

Act of 1970 (P.L. 91-616), as amended, relating to

nondiscrimination on the basis of alcohol abuse or

alcoholism; (g) §§523 and 527 of the Public Health

Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee3), as amended, relating to confidentiality of alcohol

and drug abuse patient records; (h) Title VIII of the

Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as

amended, relating to nondiscrimination in the sale,

rental or financing of housing; (i) any other

nondiscrimination provisions in the specific statute(s)

under which application for Federal assistance is being

made; and, (j) the requirements of any other

nondiscrimination statute(s) which may apply to the

application.

Will comply, or has already complied, with the

requirements of Titles II and III of the Uniform

Relocation Assistance and Real Property Acquisition

Policies Act of 1970 (P.L. 91-646) which provide for

fair and equitable treatment of persons displaced or

whose property is acquired as a result of Federal or

federally-assisted programs. These requirements apply

to all interests in real property acquired for project

purposes regardless of Federal participation in

purchases.

Will comply, as applicable, with provisions of the

Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328)

which limit the political activities of employees whose

principal employment activities are funded in whole or

in part with Federal funds.

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3.

4.

5.

6.

7.

8.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE

APPLICANT ORGANIZATION DATE SUBMITTED

Standard Form 424B (Rev. 7-97) Back

Will comply, as applicable, with the provisions of the DavisBacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act

(40 U.S.C. §276c and 18 U.S.C. §874), and the Contract

Work Hours and Safety Standards Act (40 U.S.C. §§327-

333), regarding labor standards for federally-assisted

construction subagreements.

Will comply, if applicable, with flood insurance purchase

requirements of Section 102(a) of the Flood Disaster

Protection Act of 1973 (P.L. 93-234) which requires

recipients in a special flood hazard area to participate in the

program and to purchase flood insurance if the total cost of

insurable construction and acquisition is $10,000 or more.

Will comply with environmental standards which may be

prescribed pursuant to the following: (a) institution of

environmental quality control measures under the National

Environmental Policy Act of 1969 (P.L. 91-190) and

Executive Order (EO) 11514; (b) notification of violating

facilities pursuant to EO 11738; (c) protection of wetlands

pursuant to EO 11990; (d) evaluation of flood hazards in

floodplains in accordance with EO 11988; (e) assurance of

project consistency with the approved State management

program developed under the Coastal Zone Management

Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of

Federal actions to State (Clean Air) Implementation Plans

under Section 176(c) of the Clean Air Act of 1955, as

amended (42 U.S.C. §§7401 et seq.); (g) protection of

underground sources of drinking water under the Safe

Drinking Water Act of 1974, as amended (P.L. 93-523);

and, (h) protection of endangered species under the

Endangered Species Act of 1973, as amended (P.L. 93-

205).

Will comply with the Wild and Scenic Rivers Act of

1968 (16 U.S.C. §§1271 et seq.) related to protecting

components or potential components of the national

wild and scenic rivers system.

Will assist the awarding agency in assuring compliance

with Section 106 of the National Historic Preservation

Act of 1966, as amended (16 U.S.C. §470), EO 11593

(identification and protection of historic properties), and

the Archaeological and Historic Preservation Act of

1974 (16 U.S.C. §§469a-1 et seq.).

Will comply with P.L. 93-348 regarding the protection of

human subjects involved in research, development, and

related activities supported by this award of assistance.

Will comply with the Laboratory Animal Welfare Act of

1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et

seq.) pertaining to the care, handling, and treatment of

warm blooded animals held for research, teaching, or

other activities supported by this award of assistance.

Will comply with the Lead-Based Paint Poisoning

Prevention Act (42 U.S.C. §§4801 et seq.) which

prohibits the use of lead-based paint in construction or

rehabilitation of residence structures.

Will cause to be performed the required financial and

compliance audits in accordance with the Single Audit

Act Amendments of 1996 and OMB Circular No. A-133,

"Audits of States, Local Governments, and Non-Profit

Organizations."

Will comply with all applicable requirements of all other

Federal laws, executive orders, regulations, and policies 

governing this program.

9.

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17.

18.